Living the Lie

I’ve been living a lie all these years it would seem. I always thought it was okay to like some things and not others. Some people, and not their friends… All my life I’ve wandered between likes and dislikes like a child in a supermarket, never wedded to a particular product, always willing to abandon a favourite for another on the shelf –catholic in my tastes, philosophical in my choice. Never absolute in my dismissal, ever willing to reconsider, I felt that it was my duty –my privilege- to sample from every counter. How else to explore the Umwelt?

But I have finally been unmasked it seems; no longer can I plead ambivalence. Capriciousness is not an option. My protean worldview is not seen as versatility. Apparently, it doesn’t even qualify as adaptive. Unbeknownst to me, it is a manifestation of implicit bias. It is part of a pandemic. http://www.bbc.com/news/magazine-40124781

It would seem that explicit bias has been falling over the years  –at least until the populist movements have re-emerged Phoenix-like in Europe and the USA- but ‘implicit bias – bias that we harbour unintentionally – is much stickier, much more difficult to eradicate. At least that’s the claim.’ Testing for this has become popular with many firms. ‘Jules Holroyd, an expert in implicit bias at Sheffield University, traces some of the test’s success to its providing an explanation “for why exclusion and discrimination of various forms persist. And that explanation,” she adds, “is really appealing since it doesn’t need to attribute ill-will or animosity to the people who are implicated in such exclusion.”’

I have to say, though, that in my case it is certainly subtle –a shadow that follows silently in my footsteps. And, like my conscience, I suppose, I only really know it’s there if I look. The BBC article describes a test –the Implicit Association Test (IAT)- that purports to unearth it. Exhume it, if you will. It’s one of those psychologically clever tests that almost tachistoscopically presents images and words to discover what it is you actually associate with what… They offer the ability to do the test online, but I wasn’t able to figure out the words and pictures fast enough, so I gave up.

And, thank goodness for my peace of mind, the IAT –ubiquitous as it appears to be- has its problems. Replicability seems key: ‘One reason for this is that your score seems to be sensitive to circumstances in which you take it. It’s possible that your result will depend on whether you take the test before – or after – a hearty lunch.’ But, ‘More fundamentally, there appears to a very tenuous relationship between the IAT and behaviour.’

There are many manifestations of implicit bias, I’m sure. And many ways to detect it as well. The owners of CVs with Caucasian-sounding names seem to get more jobs. So do male versus female names. Or how about cultural stereotypes? ‘The claim that most of us suffer from various forms of implicit bias is all of a piece with the explosion of research into the irrationality of our reasoning, decisions and beliefs. We are not the cogent, systematic and logical creatures we might like to assume.’

Mea Culpa. I don’t normally pick up hitchhikers. I don’t think it’s usually because I don’t trust them –it’s sometimes because I’ve been shopping and the seats are bag-laden, or I don’t see them in time to stop safely. More often, though, it’s because I just don’t feel like it.

I was driving across Canada a few years ago, and one stormy evening on my way to a little prairie town where I hoped to spend the night I saw a bedraggled figure on the side of a lonely stretch of the highway. I couldn’t see very clearly in the driving rain, but it did have its thumb out so I stopped. The road was empty and I hadn’t even seen a car going in either direction for a long time. For that matter I hadn’t seen any buildings or other roads either; I wondered where the poor soul had come from.

The figure, still in rain-drenched shadows, was wearing a dark sodden hoodie and torn jeans when it came up to my window and smiled. I unlocked the door and smiled back as the stranger climbed into the car.

“Gee, thanks mister,” an unmistakably older female voice said from somewhere inside the hood. “Been standing there for almost an hour…” She wiped the moisture off her face with her even wetter sleeve and stared out the front windshield, smiling at nothing in particular. “Couple of cars passed me a while back, but they didn’t even slow down…” she continued in a matter-of-fact voice that seemed to betray no resentment.

“The place I picked you up seems a long way from anywhere,” I said, curious as to why she’d been standing there.

She shrugged. “My man and I live in a cabin further in from the road,” she responded, still staring out of the window. “There’s a little path…” she added, sensing my unfamiliarity with the region. She turned her head and watched me struggling with the road for a moment. “Where you from?”

I glanced at her quickly –it was all the time I could spare- and smiled again. “West coast… Vancouver, I suppose.”

“Suppose?” She seemed amused at the uncertainty I had just exposed.

I shrugged and peered out between the frantic wipers. “We moved a lot when I was younger.”

She stared silently at the rain lashing the windshield for a while and then turned to me again. “I’ve lived here all my life. Many of my people left, but I stayed…” And with that, she resumed her contemplation of the rain.

“Your people…?” I didn’t mean to pry, but I was curious about someone standing on the side of the road at night in the rain, far from anywhere.

“I’m an Indian,” she said with a moist toss of her head to free her hair from the hoodie clinging so damply to her shoulders. “Sorry,” she added when she noticed she’d sprinkled water over the dashboard.

“Don’t be,” I responded with a chuckle and showed her the dust that had already accumulated from my trip.

We sat in silence for a few minutes again. “Why did you pick me up?” she suddenly said in a soft voice.

“Mmmh?” I wondered if I’d heard her properly.

“Nobody but my people usually pick me up…” She stared at me for a second or two, her face genuinely puzzled. “Don’t you think you were taking a risk?”

It was my turn to be puzzled. “You mean by picking up a person in a storm?”

She examined my face and frowned. “Nobody likes us around here. Nobody trusts us…” She thought about that for a few seconds. “Did you know what I was before you stopped?”

I have to admit I chuckled at her question. “A bedraggled person hitchhiking by themselves in the dark -far from anywhere? In the pounding rain…? Is there more I should know?”

Her face lightened and in the headlights of a lone car speeding the other way, I thought I could see a sparkle in her eyes as she nodded her head. “Yes,” she said. “I think there is…”

Surprised, I tore my eyes away from the road briefly and glanced at her -glanced at the hand she was moving slowly towards me.

“My name,” she said and giggled like a little girl.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Advertisements

Nudging Childhood Obesity

When I was a kid, obesity was not the norm. Admittedly, this was a long time ago, and no doubt I only remember brief and highly selective snippets of the time –modified, no doubt, to serve whatever demands are required in the present. But in these unexpurgated, sketches, I have memories of labeling the occasional child in the playground as ‘fat’. Whoever it was stood out from the rest –ex gregis in the true etymological sense of the word ‘egregious’- and so through the insouciance of childhood, were forever condemned to wear the epithet like a poorly fitting sweater.

Maybe we just didn’t have enough to eat in those halcyon days of early Winnipeg; maybe the winters were too severe and the necessary clothes too heavy to allow the accumulation of excessive girth. But let’s face it, normal is what we see around us. It is parochial. It is the statistics of one box. And yet, isn’t that how we judge: by what we know? If I am obese, and my child is too, then what’s the problem? And if all his friends, and all my friends are large, then how am I to adjudicate another norm? Thin is aberrant, not fat.

I came across an interesting article in Forbes magazine reporting about a study –several studies, in fact- demonstrating the inability of parents to judge whether or not their child was overweight: http://www.forbes.com/sites/alicegwalton/2015/03/30/can-you-tell-if-your-child-is-overweight-most-parents-cant-study-finds/

This is worrisome, to say the least -unless of course you change the definition of what weight is normal… But no matter the norm, health risks for diabetes, hypertension and cardiovascular disease generally increase with increasing BMI (Body Mass Index -which is the weight in kilograms divided by the square of the height in meters: kg/m2).

And it is difficult to rationalize the increasing prevalence of corpulence in the population as an evolutionary process. It’s hard to understand how plumpness would be of any survival benefit, or why it would be selected for in a gene pool. There exist islands of controversy in this, of course: http://www.bbc.com/news/magazine-28191865  But I think most analyses would suggest that obesity (BMI >30 -at least in North American population studies) adversely influences health and life span. So it would make sense to attempt to correct the issue as early as possible.

As an obstetrician, I am drawn to the idea that management of pregnancy and birth weight are important. I was intrigued by a prediction model I saw reported in the BBC from 2012 suggesting the risks for subsequent obesity of a child could be predicted at birth with about 80% accuracy: http://www.bbc.com/news/health-20509577  I haven’t seen much about this recently, so I don’t know how well it has stood the test of scientific scrutiny, but at least it was an interesting thesis. A start.

Recently, the Canadian Task Force on Preventive Health published an update on childhood obesity guidelines: http://www.cbc.ca/news/health/child-obesity-charts-open-door-to-treatment-1.3014832  It contains the usual admonitions against junk food and physical inactivity, of course, but advocates some innovative strategies, I think. For example, because the circadian rhythms of teenagers have been found to differ from the adults who are teaching them, it recommended starting classes later in the morning and suggested breaks in each class. And walking to school, where feasible, as part of the exercise regime… Dr. Brian Goldman, host of CBC’s ‘White Coat, Black Art’ program, while agreeing with the guidelines, detected some downsides to the recommendations however: http://www.cbc.ca/radio/whitecoat/blog/the-cure-for-childhood-obesity-parents-will-hate-1.3014981

The contributing factors to obesity –let alone childhood obesity- are legion: genetics, dietary habits, social milieu, parental influences, environmental conditions, Media, socioeconomic status, and peer group expectations, to name a few. None are solely responsible, but unless there are some counteracting forces –incentives- all are important. Behaviour, habits, and expectations are learned phenomena and it may be something as simple as imitation of parents or friends that starts it off and then sustains it.

When faced with uncountable opponents and overwhelming odds, how can Society possibly succeed in changing things? Well, simplistically, it needs to change attitudes. Change what the majority considers acceptable. Change the mythos. It is slowly changing the acceptability of smoking as a norm; even the legitimacy of drinking and driving is under scrutiny –not only in the courts but also in the minds of drinkers. Some things are just not seen as cool nowadays.

But, given the importance of preventing childhood obesity for the health and well-being of future generations and given the relative lack of success so far, I think we need a new (old?) approach. There is a freshly-named, although age-old practice, termed ‘Nudge Theory’. It is a euphemism that my mother would have simply called manipulation because, although cleverly disguised, that’s really what it is. Wikipedia has succinct explanation: Nudge theory (or Nudge) is a concept in behavioral science, political theory and economics which argues that positive reinforcement and indirect suggestions to try to achieve non-forced compliance can influence the motives, incentives and decision making of groups and individuals, at least as effectively – if not more effectively – than direct instruction, legislation, or enforcement. Here are two introductions –take your choice:  http://www-2.rotman.utoronto.ca/facbios/file/GuidetoNudging-Rotman-Mar2013.ashx.pdf or http://www.businessballs.com/nudge-theory.htm

Education, and early identification and treatment of those at risk of becoming obese are obviously important and desirable, but I think we need something more. Something with a proven track record, albeit in different fields. Maybe ad campaigns and directed manipulation –sorry, nudging– would be valuable adjuncts. We are media savvy nowadays, and used as a tool for change, it seems ideal. As long as we are certain of our goals, and the science is correct, I think it is an ethically acceptable approach, and one with great potential.

I did, though, run across a light-hearted, but nonetheless cautionary article about nudging in the Toronto Globe and Mail: http://www.theglobeandmail.com/globe-debate/im-an-adult-stop-nudging-me/article20925672/

However, we have to take advantage of all the tools at our disposal. My mother’s manipulation was unsubtle and in my face; nudging is not. If we are going to be successful in stopping the steadily increasing tide of obesity, we need to revise expectations, and change what we accept as normal. We have to alter folkways and mores –in other words the rules that society uses to guide behavior. Nudge them, I suppose…

We need the courage to try novel approaches. There is a quote by Erasmus that is germane: A nail is driven out by another nail. Habit is overcome by habit. Okay, so let’s change them. Nudge them. No! I hate the verbal evasion. Let’s mold them.